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Paperwork ]Lteduction Act Notice Public reporting burden for this collection of information is estimated to vary from a range of ]0 hours as en average per response for some minor facilities, to 110 hours as an average per response for some major facilities, with a waighted average for major and minor facilities of 18 hours par response, including time for revie'HUtg instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this wllection of information, including sugge:.tions for reducing this burden, to Chief, Information Policy ~ Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S\V Washington, DC 20460; end to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. --- General Instructions 1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted. 2. Enter 'Permittee Nome/Ma+ling Address (and facility name/location, if tlif7crent)," "Permit Number," and "Discharge A'un+ber" where indicated. (A separate form is required far each discharge.) 3. Enter dates bcgimting and ending 'Alonitoring Period" covered by Corm where indicated. 4. Emer each "Parameter" as specified in monitoring requirements of permit. 5. Enter ':Sample .lfeasuremenY' data for each parameter under "Quont+tY" and "Qual+hc" in units specified in penni[. "Average" is normalh arithmetic average (geometric avcmgc for bacterial parameters) of all sample measztrements (or raeh parameter obtained during ":11nm(nring Period"; "tlax+mu+.7" ar.d "Almnnum" are normally extreme 1•.iglr and low measurements obtained during "Vloniforing !'cond." (Alote to mur~cipals with secondary trr'.'msnt requirement Enter 30~ay average of sample measurements under "Average," and enter maumum 7-day average of sample measurements obtained during monitoring period under ",4laximum. 6. Enter "Fermi( RequiremenP' (or each pararnetet under "Qumttity° and "Quality" as specified in permit. 7. Under "Nn Es" curer number of sample measurmems during monitoring period that exceed maeimtrm (and/or minimum or 7-day average as appropriate) permit rcquiremcnt (or each parameter. >t none, enter "D". 8. Enter "Frequency ojAnalysis" bath as "Sam/~!e .Lleasurnent" (actual frequency of sampling and analysis used during monitoring period) and as "Permit Requiremen(" spec~cd in permit. (e.g., Enter "Coot," for continuous monitoring, "M" for one day per week, "!.'30" for one day per month, "I/90" for one day per quarter, etc.) 9. Enter "Sample Tvpe" both as "Sample tifeasurernent" (actual sample type rued during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" far individual sample, "24NC"' for 24-hour composite, "N/r'" for continupus monitoring, etc.) 10. Where violations of permit requirements are sported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by dine. l 1. TF"no dlscharge" occurs during monitoring pert ad, enter "No Discharge" across form in place of data entry. 12. Enter "Name/title ojPrincipa! Esecvtive O~~er" with "Signature ojPrincipn! Fsecutive Officer ojAuthori.-ed Agent," "Telephone Number," and "Dale" at bottom of form. 13. Mail signed Report to Office(s) by date(s) specified in perntit. Retain copy for your records. 14. More detailed instructions for use of this Dischnrge Afonitoring Report fDMR) form may be obtained from Office(s) specified in permit. Legal Notice This report is required by law (33 U.S.C. 1318; 40 C'. F. R. 125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed S10,ooo per day of violation; or in criminal penalties not to exceed 525,000 per day of violation, or by imprisonment for not more than one: year, or by both. EPA Fotm 3320-1 (Rev. 08-95)